Newly Published
Perioperative Medicine  |   September 2017
Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients
Author Notes
  • From the Harvard Medical School, Boston, Massachusetts (D.J.C., D.F., J.L.R., H.J., A.M.B., B.T.H., D.B., G.C.); Departments of Anesthesiology, Perioperative and Pain Medicine (D.J.C., D.F., M.C.F., C.-C. H., A.M.B., G.C.), Medicine (J.L.R., H.J.), Orthopedic Surgery (J.W.), Brigham and Women’s Hospital, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts (B.T.H.); Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts (D.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts (D.B.).
  • Submitted for publication October 6, 2016. Accepted for publication July 28, 2017.
    Submitted for publication October 6, 2016. Accepted for publication July 28, 2017.×
  • Research Support: Supported by Anesthesia Patient Safety Foundation (Rochester, Minnesota) and grant No. AG048522 from the National Institutes of Health (Bethesda, Maryland; to Dr. Culley); grant No. AG048637 from the National Institutes of Health (Bethesda, Maryland; to Dr. Crosby); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.
    Research Support: Supported by Anesthesia Patient Safety Foundation (Rochester, Minnesota) and grant No. AG048522 from the National Institutes of Health (Bethesda, Maryland; to Dr. Culley); grant No. AG048637 from the National Institutes of Health (Bethesda, Maryland; to Dr. Crosby); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.×
  • Competing Interests: Dr. Culley serves as director of the American Board of Anesthesiology, chair of the American Board of Medical Specialties (Chicago, Illinois) Committee on Continuous Certification, Accreditation Council for Graduate Medical Education, Anesthesiology Residency Review Committee, ad-hoc member (Chicago, Illinois), executive editor of Anesthesiology, American Society of Anesthesiologists committee member; receives grant funding from CRICO (Boston, Massachusetts), NIA; has lectured at the Department of Anesthesiology, The State University of New York, Department of Anesthesiology, Maine Medical Center, Washington State Society of Anesthesiology, Virginia Mason Medical Center, University of Florida (Jacksonville), Mayo Department of Anesthesiology, and the University of Alabama. Dr. Crosby receives grant funding from CRICO; serves as editor of Anesthesia and Analgesia, as an American Society of Anesthesiologists committee chair and member, and on the Scientific Advisory Board of The Medicines Company; has lectured at New York Postgraduate Assembly, California Society of Anesthesiologists, American Society of Anesthesiologists, and International Anesthesia Research Society. All other authors declare no competing interests.
    Competing Interests: Dr. Culley serves as director of the American Board of Anesthesiology, chair of the American Board of Medical Specialties (Chicago, Illinois) Committee on Continuous Certification, Accreditation Council for Graduate Medical Education, Anesthesiology Residency Review Committee, ad-hoc member (Chicago, Illinois), executive editor of Anesthesiology, American Society of Anesthesiologists committee member; receives grant funding from CRICO (Boston, Massachusetts), NIA; has lectured at the Department of Anesthesiology, The State University of New York, Department of Anesthesiology, Maine Medical Center, Washington State Society of Anesthesiology, Virginia Mason Medical Center, University of Florida (Jacksonville), Mayo Department of Anesthesiology, and the University of Alabama. Dr. Crosby receives grant funding from CRICO; serves as editor of Anesthesia and Analgesia, as an American Society of Anesthesiologists committee chair and member, and on the Scientific Advisory Board of The Medicines Company; has lectured at New York Postgraduate Assembly, California Society of Anesthesiologists, American Society of Anesthesiologists, and International Anesthesia Research Society. All other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Culley: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston, Massachusetts. 02115. dculley@bwh.harvard.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Geriatric Anesthesia
Perioperative Medicine   |   September 2017
Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients
Anesthesiology Newly Published on September 14, 2017. doi:10.1097/ALN.0000000000001859
Anesthesiology Newly Published on September 14, 2017. doi:10.1097/ALN.0000000000001859
Abstract

Background: The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications.

Methods: We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses.

Results: Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2.

Conclusions: Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.